Information Collection

Applicant's Benefits Calculation Worksheet

IC 185903 under ICR 202402-1660-004 · OMB 1660-0017.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form FF-104-F Applicant's Benefits Calculation Worksheet	Form and Instruction
FEMA Form FF-104-F Applicant's Benefits Calculation Worksheet FEMA Form FF-104-FY-21-135 Applicant's Benefits Calculations.pdf portal.fema.gov	Form and Instruction
FEMA Form FF-104-F Applicant's Benefits Calculation Worksheet FEMA Form FF-104-FY-21-135 Applicant's Benefits Calculations.pdf portal.fema.gov	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 44 CFR 206

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FEMA Form FF-104-FY-21-135 (formerly 009-0-128)	Applicant's Benefits Calculation Worksheet	FEMA Form FF-104-FY-21-135 Applicant's Benefits Calculations.pdf	https://portal.fema.gov	Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records

Title: DHS/FEMA-009-Hazard Mitigation, Disaster Public Assistance, and Disaster Loan Programs System of Records

FR Citation: 79 FR 16015

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,920	1,920
Annual IC Time Burden (Hours)	960	960
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.